Abdominal Injuries without Hemoperitoneum

TLDR

Focused abdominal sonography for trauma (FAST) detects hemoperitoneum, but blunt trauma victims with abdominal injury yet no hemoperitoneum are at risk of missed injury, prompting prospective data collection on such patients. The study examined all FAST‑negative patients, evaluating their physical exam findings and associated injuries to identify associations with abdominal lesions. Among 772 blunt trauma victims, 52 (7%) sustained abdominal injury, 15 (29% of those) had no hemoperitoneum and all were FAST‑negative, splenic injuries required laparotomy in 4 cases and were managed nonoperatively in 6, hepatic injuries were managed nonoperatively in 5, key clinical risk factors were identified, and up to 29% of abdominal injuries could be missed if FAST alone is used, suggesting that incorporating exam findings can reduce missed injuries.

Abstract

Focused abdominal sonography for trauma (FAST) relies on hemoperitoneum to identify patients with injury. Blunt trauma victims (BTVs) with abdominal injury, but without hemoperitoneum, on admission are at risk for missed injury.Clinical, radiologic, and FAST data were collected prospectively on BTVs over a 12-month period. All patients with FAST-negative for hemoperitoneum were further analyzed. Examination findings and associated injuries were evaluated for association with abdominal lesions.Of 772 BTVs undergoing FAST, 52 (7%) had abdominal injury. Fifteen of 52 (29%) had no hemoperitoneum by admission computed tomographic scan, and all had FAST interpreted as negative. Four patients with splenic injury underwent laparotomy. Six other patients with splenic injury and five patients with hepatic injury were managed nonoperatively. Clinical risk factors significantly associated with abdominal injury in BTVs without hemoperitoneum include: abrasion, contusion, pain, or tenderness in the lower chest or upper abdomen; pulmonary contusion; lower rib fractures; hemo- or pneumothorax; hematuria; pelvic fracture; and thoracolumbar spine fracture.Up to 29% of abdominal injuries may be missed if BTVs are evaluated with admission FAST as the sole diagnostic tool. Consideration of examination findings and associated injuries should reduce the risk of missed abdominal injury in BTVs with negative FAST results.